HSV1 question

Dear Dr. Handsfield,
About 13 years ago I had a small single lesion on my vagina and was diagnosed with HSV. A few months later I experienced what I assumed was a recurrence-it was a large ulcer where the pubic hair is. A few months later a similar lesion appeared on my face and left a scar..and months later on my elbow and alsao left a scar. The only one I am certain was hsv was the one on my genitals.  I never had another lesion of that kind. This year I took a blood test and found I have hsv1. About 8 years ago I started getting a small single bump on my right inner thigh on the bikini line (towards the front-not back). It has never turned to an ulcer. Over the years it seems so have changed in two ways--one is that now it alternates between right and left and now the bump has a yellowish pus. The bump either goes away in a couple of days or in a day if I apply a warm compress or squeeze it. in either case it does not leave an ulcer and does not hurt at all but it continues to recur every couple of months.  It isn't really a bump with a head but looks more like it's under the skin and once it's popped the skin is completely normal. It's not fragile like the blister I had years ago and If I look closely at my bikini area I can see tiny bumps under the skin (it looks a little like chicken skin) I recently had a culture done of the bump. The Dr. popped it so it was fresh. It came back NEGATIVE for HSV.  After reading about the high rate of false recurrences on the net however, I became skeptical. My questions are:
1. does this sound like herpes and why or why not?
2. If not herpes what else could it be? does folliculitis recur?
3.why would I have gotten lesions on my face and elbow?
4. where exactly on the inner thigh does herpes appear (front, back, bikini line) and does it alternate sides?
5. have you heard of anyone with oral hsv since childhood contracting hsv1 genitally in adulthood? how likely is it?

I apprectiate your help

[H. Hunter Handsfield, M.D.]

I'll try to help. First, it would be helpful to know whether the initial diagnosis of genital herpes was based solely on examination of the lesion, or also on lab testing.  If a culture or PCR (DNA) test for HSV was positive, that nails the diagnosis for sure.

If the initial episode was genital herpes, it was due to HSV-1; otherwise the blood test would have been positive for HSV-2.  But without knowing the result of an HSV test on the initial lesion, I cannot tell whether your the positive blood test is due to that infection or to an earlier childhood infection with the virus.  (Half of all adults in the US have positive HSV-1 tests, mostly due to childhood infection, with or without known oral herpes outbreaks.)  

As to all the other things you describe -- lesions on the face, elbows, inner thigh, etc -- there is no realistic chance that any of them is due to HSV.  Same for "tiny bumps under the skin" of the bikini line or anywhere else.  Recurrent genital herpes doesn't usually involve the pubic hair area.  The negative test from the recently popped lesion is exactly what I would suspect, since herpes definitely isn't the cause.

And so to the specific questions:

1) Of all the symptoms you describe, only the iniital genital ulcer might have been herpes due to HSV-1.  Even if that's what it was, you might not ever have a recurrent oubreak.  Repeated genital herpes outbreaks are mostly a problem of HSV-2, not genital HSV-1.  As to why it doesn't sound like herpes, HSV just doesn't cause the sorts of symptoms you describe.  Recurrent herpes ourbreaks always occur every time in more or less the same spot, give or take an inch.  Such widespread skin problems cannot be herpes.

2) Folliculitis definitely recurs, but most of what you describe doesn't sound like folliculitis any more than herpes.

3) Not from herpes; see above.

4) Herpes outbreaks never alternate from one side of the body to the other.  See the comment above about herpes recurrences always happening at more or less the same spot every time.

5) I have never seen a case of genital HSV-1 in someone who had oral herpes since childhood.  If that happens at all, it is very rare.

Bottom line:  You need to work with your health care provider about the actual cause(s) of the various skin problems you describe; they aren't herpes.  If you have not seen a dermatologist, that would be a good step.

I hope this helps.  Best wishes-- HHH, MD

[ll3]

Thank you very much for your quick response. FYI..the original lesion was confirmed through a culture but never recurred in or near that spot. The only recurring bumps I have are on the inner thigh/bikini line. when I had asked my dr what it was when she told me it wasn't herpes she said probably just a boil. I never heard of recurring boils and compared to what I read on the net mine seemed too small and aren't at all painful.   I guess I will have to speak to another Dr. about why it continues to recur-whatever  it is . I know I''ll have herpes forever but it puts my mind at ease to know that most people already have HSV-1 and that atleast for now (and hopefully forever its non-recurring)

[H. Hunter Handsfield, M.D.]

Recurring boils are very common, and the location you describe -- the crease between the thigh and groin -- probably the most common site.  Herpes outbreaks and boils are not similar at all; they don't look similar and don't behave the same way; the two conditions would never be confused by a knowledgeable provider.

Since you haven't had a repeat outbreak of your genital HSV-1 for 13 years, most likely you never will; and you probably are not infectious for sex partners.  This really shouldn't be a worry for you.

[ll3]

You've been very helpful.
Thank you!